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' Initial Application Date: np Application # t 0 - 500-24q 21 ir
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street, Lillington, NC 27546 Phone: (910) 893 -7525 Fax: (910) 893 -2793 www.hamett.orgfpermits
roO ����eAwAC- ;''Q.14'o 3• 14600.151.4.‘ %o A 1 ,j
LANDOWNER: 14600 Mailing Address: S34 owe,,'t".. /� 1-44„..._
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City: j . 11. n3+ State: 1 Zip:2-9t''/�bntact # / I 0 ?lb Y Zy Z Email: •-(t t .. 4 le eH.L 7 0„... 'r &.
APPLICANT*: L Mailing Address: �✓
City: State: Zip: Contact # Email:
'Please fill out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICE: 7rk't Phone #
PROPERTY LOCATION: Subdivision: J ` v.i t ._ $ ,`t Lot #: Z Lott Size: / ' 3
State Road # iZ 34 State Road Name: (7r 4 ,(e / o L qi0 e / Map Book &Page: ✓ � /
Parcel: 5 /b Q/6 2 \ oaPIN: 0 6 I / D ' — 4/ C-" a 7 /!Z, OG
f/ F
Zoning: 7lood Zone: X Watersha eed Book &Page: 7I o/ 7 O { O Power Company:
New structures with Progress Energy as service provider need to supply premise number 1 from Progress Energy.
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SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: S 42 1'�irovv. L. \\„r..{- -9A 5'(k ���
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g A ID tr'IALt. Lee' 6... t-lan..2_."S '2k kikn-Lr- Ca it sillf 5tilt .
i2 i Q P j ( t ' 6ti 1 / 4 - Net. ct. 1 - 1 - 2 _ 1 , . Z d s-L-tC- `R ct (v.. Leff- 15 G rcvrr..t�t,., La,.l
Sri( 0 VI_ t". 61).0v, 1r. R,
PROPOSED USE:
❑ SFD: (Size _x_) # Bedrooms: _ # Baths: _ Basement (w /wo bath): Garage: Deck: _ Crawl Space: _ Slab:
.! (Is the bonus room finished? (_) yes (_)no wf a closet? (_) yes ( )no (if yes add in with # bedrooms)
Mod: (Size 1 x Z) # Bedrooms 3 # Baths 2 Basement (w /wo bath)_ Garage: Site Built Deck: r. On Frame_ Off Frame )C,
(Is the second Floor finished? () yes ())no Any other site built additions? ( •� _) yes t )no
❑ Manufactured Home: _SW _DW TW (Size_ x ) # Bedrooms: _ Garage: (site built ?) Deck: (site built ?)
❑ Duplex: (Size x_) No. Buildings: No. Bedrooms Per Unit:
❑ Home Occupation: # Rooms: Use: Hours of Operation: #Employees:
❑ Addition /Accessory/Other: (Size x) Use: Closets in addition? ( ) yes (_)no
Water Supply: v7 / Existing Well New Well (# of dwellings using well ) 'MUST have operable water before final
Sewage Supply: J New Septic Tank (Complete Checklist) Existing Septic Tank (Complete Checklist) County Sewer
Does owner of this tract of land, own land that contains a manufactured home within five hundred feet (500') of tract listed above? (J) yes (_)no
Structures (existing or proposed): Single family dwellings: l '4G, Mop Manufactured Homes: - Other (sp ;city): t Lir 5roca4 E
Required Residential Property Line Setbacks: , Commegts: -- 2 - 0 / , 4 4 .1 i . < r ,/ Front Minimum ✓ f Actual / 34 /_ • / 01' 1 7
Rear 2C / „�t'i3a
Closest Side qq/(/ 30
Sidestreel/comer lot a° ./`
Nearest Building (O 11
on same lot
If permits are granted I agr; : o conform to all ordinances and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that f. egoin 't m nts a accurate and correct to the best of my knowledge. Permit subje to revocation it false information is provided.
Signature of Owner or Owner's Agent Date
'"This application expires 6 months from the initial date if permits have not been Issued"
A RECORDED SURVEY MAP, RECORDED DEED (OR OFFER TO PURCHASE) AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
Residential Land Use Application 1 of 1 03110
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